Exploring the complexity and spectrum of racial/ethnic disparities in colon cancer management

Int J Equity Health. 2023 Apr 14;22(1):68. doi: 10.1186/s12939-023-01883-w.


Background: Colorectal cancer is a leading cause of morbidity and mortality across U.S. racial/ethnic groups. Existing studies often focus on a particular race/ethnicity or single domain within the care continuum. Granular exploration of disparities among different racial/ethnic groups across the entire colon cancer care continuum is needed. We aimed to characterize differences in colon cancer outcomes by race/ethnicity across each stage of the care continuum.

Methods: We used the 2010-2017 National Cancer Database to examine differences in outcomes by race/ethnicity across six domains: clinical stage at presentation; timing of surgery; access to minimally invasive surgery; post-operative outcomes; utilization of chemotherapy; and cumulative incidence of death. Analysis was via multivariable logistic or median regression, with select demographics, hospital factors, and treatment details as covariates.

Results: 326,003 patients (49.6% female, 24.0% non-White, including 12.7% Black, 6.1% Hispanic/Spanish, 1.3% East Asian, 0.9% Southeast Asian, 0.4% South Asian, 0.3% AIAE, and 0.2% NHOPI) met inclusion criteria. Relative to non-Hispanic White patients: Southeast Asian (OR 1.39, p < 0.01), Hispanic/Spanish (OR 1.11 p < 0.01), and Black (OR 1.09, p < 0.01) patients had increased odds of presenting with advanced clinical stage. Southeast Asian (OR 1.37, p < 0.01), East Asian (OR 1.27, p = 0.05), Hispanic/Spanish (OR 1.05 p = 0.02), and Black (OR 1.05, p < 0.01) patients had increased odds of advanced pathologic stage. Black patients had increased odds of experiencing a surgical delay (OR 1.33, p < 0.01); receiving non-robotic surgery (OR 1.12, p < 0.01); having post-surgical complications (OR 1.29, p < 0.01); initiating chemotherapy more than 90 days post-surgery (OR 1.24, p < 0.01); and omitting chemotherapy altogether (OR 1.12, p = 0.05). Black patients had significantly higher cumulative incidence of death at every pathologic stage relative to non-Hispanic White patients when adjusting for non-modifiable patient factors (p < 0.05, all stages), but these differences were no longer statistically significant when also adjusting for modifiable factors such as insurance status and income.

Conclusions: Non-White patients disproportionately experience advanced stage at presentation. Disparities for Black patients are seen across the entire colon cancer care continuum. Targeted interventions may be appropriate for some groups; however, major system-level transformation is needed to address disparities experienced by Black patients.

Keywords: Colon cancer; Colorectal surgery; Healthcare access; Racial disparities.

MeSH terms

  • American Indian or Alaska Native / statistics & numerical data
  • Asian / statistics & numerical data
  • Black or African American / statistics & numerical data
  • Colonic Neoplasms* / epidemiology
  • Colonic Neoplasms* / ethnology
  • Colonic Neoplasms* / mortality
  • Colonic Neoplasms* / therapy
  • Databases, Factual / statistics & numerical data
  • East Asian People / statistics & numerical data
  • Ethnicity* / statistics & numerical data
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities* / ethnology
  • Healthcare Disparities* / standards
  • Healthcare Disparities* / statistics & numerical data
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Male
  • Native Hawaiian or Other Pacific Islander / statistics & numerical data
  • Race Factors / statistics & numerical data
  • Racial Groups* / statistics & numerical data
  • South Asian People / statistics & numerical data
  • Southeast Asian People / statistics & numerical data
  • Treatment Outcome
  • United States / epidemiology